Angiographic Features of Iris Melanocytic Tumors: Nevus versus Melanoma.

Ocul Oncol Pathol

Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA.

Published: August 2023

AI Article Synopsis

  • Determining the difference between iris melanoma and iris nevus based on clinical exams is difficult, but the presence of tumor-associated blood vessels provides helpful diagnostic information.
  • In a study involving 60 patients (45 with iris melanoma and 15 with iris nevi), researchers analyzed tumor characteristics and blood vessel patterns using clinical exams and fluorescein angiography.
  • Results showed that feeder vessels were found only in melanomas, intrinsic vessels were more common in melanomas, and fluorescein leakage was significantly higher in melanomas, indicating that angiographic assessments can effectively differentiate between these types of tumors.

Article Abstract

Introduction: Determining the nature of iris melanocytic tumors based on clinical exam alone remains challenging. Tumor-associated vasculature of iris melanocytic lesions may facilitate the ability to discern between iris nevus and melanoma.

Methods: In a single-institution, retrospective, observational study of 45 patients with pathologically confirmed iris melanoma and 15 patients with iris nevi that were either clinically stable or pathologically confirmed were included. Tumor characteristics and associated vasculature were identified on clinical exam and slit-lamp photographs. Fluorescein angiographic parameters including feeder vessels, intrinsic vessels, leakage, masking, and angiographic silence were assessed.

Results: Feeder vessels were present in 17 (43%) melanomas and were absent in the nevus group ( = 0.002). Thirty-three (83%) iris melanomas and 5 (33%) iris nevi were observed to have intrinsic vessels, and a statistically significant association of intrinsic vessels with malignancy ( = 0.001) was noted. Fluorescein leakage was also observed more frequently in iris melanoma 39 (98%) than in nevi 9 (60) with a significant difference ( = 0.001). Angiographic silence occurred in 3 nevi (20%) and was not observed in any melanoma ( = 0.017). Overall, the presence of intrinsic vessels +/- feeder vessels had high sensitivity (0.85) and high positive predictive value (0.87) for diagnosis of iris melanoma.

Conclusions: Anterior segment fluorescein angiography allows for the assessment of tumor-associated vascular patterns and demonstrates utility in differentiating iris nevi from melanoma. Feeder vessels were only observed in iris melanoma and were absent in iris nevi. The intrinsic vessels were present more frequently in melanomas and are thus associated with malignancy. Angiographic silence is indicative of iris nevi.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10433095PMC
http://dx.doi.org/10.1159/000529073DOI Listing

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